Unum Disability Appeal

I would like to give you our special formula for how to win a Unum ERISA disability appeal, but it’s simply not possible. Every Unum disability benefit denial is unique because the definition of disability is different in most Unum disability policies, everyone has different medical conditions that prevent them from working, and lastly the duties of your occupation are specific to your employer’s required daily job responsibilities. Our success in winning disability appeals comes from working very closely and strategically with you, your treating doctors, vocational consultants and an in-depth dissection of the Unum disability claim file prepared for your claim denial. Our lawyers take a custom approach to how we handle every appeal and it starts with an initial free phone consultation in which we will review your Unum disability denial letter and ask you some very specific questions. After reviewing your Unum denial letter and speaking with you, we will usually have enough information in order to determine if we can help you.

In your Unum denial letter, Unum gave you the right to request a complete copy of your claim file. ERISA regulations require Unum to prepare and send you this claim file within 30 days of a written request. Most Unum disability benefit denials are because Unum has determined that the claimant does not have sufficient medical limitations which prevent the claimant from working in a specific occupation or any occupation. The basis for Unum’s denial is required to be submitted in their denial letter, but the documents supporting the disability denial are contained in the claim file. The claim file is supposed to contain every single document, medical record, financial record, internal emails, memos and notes, your disability plan documents, video surveillance and any medical record reviews conducted by Unum. Depending on how long your disability claim has been pending, your claim file can range from 500 to 10,000 pages. The Unum claim files are often intentionally disorganized and require legal experience in order to know what information in the claim file is relevant to preparing a strong appeal. We always request the claim file for our clients and upon receipt we immediately organize and analyze the claim file so that we can prepare a plan of attack that puts our client in the best position to win disability benefits.

After our lawyers complete a full analysis of your Unum claim file and review all of your up to date medical records, we formulate a plan of attack that we believe must be followed in preparation of your Unum appeal. Our plan always includes a medical and occupational duties strategy. Every plan is anchored by determining what additional medical documentation and support we must help you obtain to prove your disability. Doctors became doctors to treat medical conditions of patients and did not receive training for how to complete insurance company disability claim form statements. Doctors usually can’t stand insurance companies and while they want to help patients they get frustrated and don’t properly document a patient’s restrictions and limitations. Treating doctors usually document medical records for purposes of treating you and are not assuming that their medical records will be dissected by a disability insurance company.

Unum insurance company takes advantage of what they call insufficient medical documentation by your doctor and often relies on it to deny your claim. Our job during the appeal process is to work with you and your treating doctors to obtain the medical documentation that we know Unum must see to support a claim. In addition, we will suggest additional diagnostic testing or medical consultations with different medical specialist if we believe it will help bolster your claim.

In some appeals we will have you undergo a functional capacity exam or an independent medical exam. In certain appeals we will submit medical literature from leading medical publications which support your symptoms, limitations and potential risks associated with your condition. In every appeal we handle we draft custom attending physician statements for each of your doctors. Our physician statements are specific to your Unum disability policy definition of disability and your specific medical condition(s). The attending physician statements drafted by Unum and previously completed by your treating doctors are generic and intentionally designed by Unum to offer limited support for your claim. Diagnosis does not equal disability. This means that we must work with your treating doctors to document your restrictions and limitations as a result of your diagnosis. Our disability lawyers are very good at getting this done and it is the most important part of a successful Unum appeal.

Your treating doctors must have a clear understanding of your occupational duties pre-disability and the duties required for you to perform any occupation that you may be qualified to perform. We have represented claimants in every occupation and have developed a very practical approach for how we present the duties of either your occupation or any occupation to your doctors. In a high percentage of disability claims the claimant must be unable to do a sedentary desk job in order to be disabled and our job is to get your doctors to properly document why you cannot do a sedentary job. Unum wrongfully thinks that if you can sit a desk for more than four hours a day, then you are capable of working. Any job requires far more than the ability to just sit in a chair for more than four hours. Unum’s method for analyzing a sedentary occupation is outrageous as no one’s job description says “must be able sit for four hours a day and nothing else required”. In disability policies that have an own occupation definition of disability we conduct our own occupation specific industry research and work closely with you and your past co-workers to present extensive documentation in support of your occupational duties.

This paragraph may contain more legal information than your care to know so I will try to make it as simple as possible. We also have a video below discussing the importance of a strategically drafted ERISA appeal and you can also call us for further clarification and help with your appeal. There is only one chance to submit a Unum appeal and it must be drafted in a manner so as to not tell Unum everything they did wrong. Most people, including lawyers that don’t focus their legal practice on Unum appeals will submit appeals where they basically give Unum a roadmap on how to review the appeal by telling Unum everything they did wrong on the initial review. They will include lots of case law and a detailed criticism of everything Unum did wrong. This is not a helpful strategy and really does nothing more than guide Unum as to how to conduct a reasonable review of your initial claim denial.

The “reasonable review” language is key because if your appeal is denied by Unum and an ERISA lawsuit is filed, a judge must review the denial and apply an unfair legal standard called “abuse of discretion”. The abuse of discretion standard requires a judge to first determine if the claimant is disabled and then if the judge thinks the claimant is disabled, the Judge can only reverse the claim denial if he or she thinks the review conducted by Unum was unreasonable. So a Judge can find that a claimant was disabled, but Unum’s review of the claim with a conclusion of not disabled was reasonable. In this scenario the claimant loses the case as the Judge must defer to the reasonable review conducted by the insurance company. Because of the abuse of discretion standard that applies to any Unum disability policy that contains a “discretionary clause”, we always draft a strategic appeal that focuses on your medical restrictions/limitations and how you are disabled in accordance with your disability policy’s definition of disability. There are a few states where the discretionary clause is illegal and the judge’s decision on the claim will be final regardless of the reasonableness of Unum’s appeal review.

Regardless of the standard of review that will apply to your Unum disability appeal denial, our have a very specific style of organizing, preparing and drafting Unum appeals letters which has helped thousands of disability claimants nationwide to receive their disability insurance benefits.

We hope you find all of the additional information we have on website about Unum helpful and we look forward to discussing your Unum disability appeal with you.